Over the counter medicine

Summary

There are an ever increasing number of medicines available without prescription which can be bought in pharmacies, supermarkets and even the local garage.

Some of these medicines are unsuitable for people with kidney disease or kidney failure.

This may be relevant whether you have poor kidney function, are on dialysis, or have had a kidney transplant.

Some of these medicines may interfere with medicines which have been prescribed for you by your doctor

Certain medicines can affect absorption of other medications, for example immunosuppressants used by transplant patients and those with immune disorders.

Some medicines may even damage any remaining kidney function

So it is important for people with kidney disease to avoid taking these harmful medicines. This is information on the treatment of minor ailments for people with kidney disease. Whenever possible medicines should be bought from a pharmacy who should be able to advise on interactions with your prescribed medicines. If your symptoms persist you should seek advice from a doctor.

The following information is meant mainly for adult renal patients but children may also take some of these medicines. The dosage of medicines needs to be carefully chosen for children, so do seek advice from your pharmacist or doctor.

Headaches

Paracetamol (Hedex ®, Panadol ® ) is safe and suitable to treat headaches. The maximum dose of paracetamol is 4grams (eight 500mg tablets) in any 24 hour period. Co-codamol, co-proxamol and some cold remedies (e.g Night Nurse ®) also contain paracetamol. Any paracetamol taken in these combination products should be included in the maximum daily dose. Paracetamol is available as tablets, capsules, syrup and soluble tablets. Soluble tablets should be avoided if possible since they are high in sodium. Any liquid needed to dissolve the tablets has to be included in the daily fluid allowance, if you are on a restricted amount of fluid.

Aspirin preparations (Alka Seltzer ®, Anadin ® Aspro clear ® Disprin ®, ) or mixtures of paracetamol with aspirin (Disprin Extra ® Anadin Extra ® Disprin Extra ®) should be avoided. Aspirin in a single daily dose of up to 150mg daily may be prescribed for people with kidney disease to thin the blood. Aspirin in painkilling doses, above 300mg daily, can worsen the function of damaged kidneys so should usually be avoided if you have kidney function less than about 50%.

Painkillers which contain ibuprofen (e.g Advil ® Anadin Ultra ® Galprofen ®, Nurofen ®) can also worsen the function of damaged kidneys so should usually be avoided if you have kidney function less than about 50%. Avoiding ibuprofen containing medicines is also important for people taking anti-rejection medicines (e.g Neoral ® [cyclosporine] or Prograf ®[tacrolimus]) after a kidney transplant.

Certain well known branded remedies may have extended their ranges - always read the labels carefully as some medicines may be included that are best avoided by kidney patients.

Always seek help from your medical professional if in any doubt. There may be circumstances where it is decided that on balance it is better for you take the painkiller, but if so it should be done with medical advice. We have suggested ‘less than 50%’ kidney function here, but the risks increase with worse kidney function – a little increased at 50%, but greater risk at 30% or less.

Coughs and colds

A cough associated with a cold can be treated with Simple Linctus (which is also available sugar-free) or ‘Glycerin and Honey’ pastilles or lozenges. . Cough medicines containing decongestants such as ephedrine, Benylin ® Dimotapp ® Lemsip ® etc) may increase blood pressure. Many people with kidney disease have high blood pressure will need to be careful with this. Instead of taking medicine to treat a ‘bunged-up’ nose, use a steam inhalation. If required menthol or olbas oil can be added to the water. Care is needed to avoid scalding. Seek advice from a doctor if a cough is persistent. Some prescribed medicines can cause a cough as a side effect.

For colds with a headache try paracetamol 1g up to four times daily.

Indigestion

For occasional treatment of indigestion a product such as Gaviscon ® Liquid or tablets can be taken. Gaviscon ®Advance should not be used as it contains potassium which may be restricted in renal disease. Remegel ® tablets which contain calcium carbonate can also be taken occasionally provided levels of calcium in the blood are not raised above normal. Aludrox ® or Maalox ® or any other aluminium or magnesium containing medicines should be only used very occasionally when prescribed by a renal doctor. This is particularly important for people on dialysis.

Ranitidine (Zantac ®), famotidine (Pepcid ®, Boots Excess Acid Control ®) and nizatidine can also be purchased for short term relief of heartburn, particularly when the symptoms are related to consumption of food and drink. Cimetidine (Tagamet ®) is also available to buy but can lead to a rise in the blood test for Creatinine, which will make it seem as if kidney function has got worse – so best avoided if there is an alternative. If indigestion persists you should seek advice from a doctor – further investigations or prescribed medicines may be necessary.

Hayfever

There are a number of antihistamine tablets which can be bought to treat hayfever. These include Piriton ® (chlorpheniramine), Clarityn ® (loratadine) and Zirtek ® (cetirizine). Piriton ® can cause drowsiness Clarityn ® and Zirtek ® are less likely to cause sedation. Antihistamines are also used to treat the itching which is sometimes a symptom of kidney disease. Some of the prescribed medicines have slightly different names –desloratadine (NeoClarityn ®) and levocetirizine (Xyzal ®) but will have the same effect. There is no need to duplicate the treatment. If the tablet taken for itching does not control the hayfever, there are also a number of nasal sprays and eyedrops you can buy (Rhinolast Allergy ®, Livostin Direct ® nasal spray and eye drops, Rynacrom ®, Vividrin ® Opticrom and Boot’s Hay fever Relief ®) all of which can be used by patients with kidney disease.

Muscle aches and pains

Topical preparation such as Deep Heat ®, Raljex ® or Tiger Balm ® can be rubbed into the affected area. Ibuleve ® (containing ibuprofen) or other anti-inflammatory creams and ointments may not be completely safe. Usually the amount getting into the body will only matter if you are allergic to these preparations since only small amounts of the active ingredient can be absorbed through the skin.

Constipation

Senna tablets or liquid are suitable for the treatment of constipation in people with kidney disease. If constipation persists medical advice should be sought. Patients being treated by peritoneal dialysis should be particularly careful not to become constipated since this can affect the efficiency of the dialysis. Bulk forming laxatives, such as Fybogel ®, are best avoided because they require high fluid intake to work. You should seek advice from a doctor if constipation is persistent.

Diarrhoea

Diarrhoea can result in fluid loss and upset fluid balance. Oral rehydration powder is sold for use in diarrhoea but since it contains both sodium and potassium it should be avoided in people with severe kidney disease except with medical advice. If the symptoms are mild, loperamide (Imodium ®) can be used to control them. If symptoms persist then seek medical advice. Patients on CAPD should be aware that sometimes diarrhoea may be a warning sign of an episode of CAPD peritonitis. If in doubt take advice from your CAPD unit.

Complementary therapies

Homeopathic medicines are safe in renal impairment but herbal and ayurvedic medicine should be avoided. A number of herbal remedies can increase blood pressure and so are unsuitable for use in people with renal disease. Herbal remedies can interact with conventional medicines, for example St. Johns Wort with cyclosporin (Neoral ®). Herbal remedies vary in the amount of active constituent they contain and the effect may differ a great deal from one batch to another. Until more is known about the effects of herbal medicines in kidney disease they cannot be recommended.

Choosing the correct ‘over the counter’ medicine for minor ailments

Condition or sympton

Recommend

Avoid

Other information

Headache

Paracetamol or Co-codamol

Aspirin. This can be taken in doses of 150mg, but no more than 300 mg per day